PAMA Resource Center

PAMA Resource Center

On January 1, 2020, CMS implemented a new mandate – section 218 of Protecting Access to Medicare Act (PAMA) – that changes the prior authorization process for ordering certain advanced diagnostic imaging studies. The education and testing period for PAMA has now been extended until January 1, 2022.

When ordering an advanced diagnostic imaging service for a Medicare beneficiary, a provider is now required to consult a qualified Clinical Decision Support Mechanism (CDSM). CDSMs are electronic portals through which appropriate use criteria (AUC) is accessed. The CDSM provides a clinical Decision Support Number (DSN) denoting if the order adheres to the AUC. The CDSM replaces the prior authorization process for Medicare patients, is faster, and provides a more specific diagnosis as well as more information on the order.

EMRs should have prepared to meet this mandate by embedding a qualified decision support mechanism within their software. Please check with your EMR to see how they will be supporting your office to meet this mandate. If your practice’s EMR will not be implementing a CDSM or if you don’t have an EMR, there are several free web portals that will provide a DSN.

Munson Healthcare is asking that any order for radiology testing (CT, MRI, PET, nuclear medicine) for a Medicare patient include a decision support number.

For more, read the PAMA FAQ.

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